Healthcare Provider Details

I. General information

NPI: 1053313882
Provider Name (Legal Business Name): KWAKU A OSAFO-MENSAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 RIVER PARK DR SUITE 100
FORT WORTH TX
76116-0921
US

IV. Provider business mailing address

2550 RIVER PARK PLZ SUITE 100
FORT WORTH TX
76116-0920
US

V. Phone/Fax

Practice location:
  • Phone: 817-348-9015
  • Fax: 817-348-9017
Mailing address:
  • Phone: 817-348-9015
  • Fax: 817-348-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberL9835
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberL9835
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: